Culturally relevant treatment services for perinatal depression in socio-economically disadvantaged women: the design of the MOMCare study.

BACKGROUND: Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services (MSS). METHODS: Pregnant, public health patients, >18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9 (PHQ-9) or the Mini-International Neuropsychiatric Interview (MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline (one-year postpartum). BASELINE RESULTS: 168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making <$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% unplanned pregnancy. CONCLUSIONS: A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study.

Homicide and suicide in Yorkshire and the Humber: 1975-1992 and 1993-2007.

Homicide-suicide (HS) events in Yorkshire and the Humber have been documented previously by Milroy in a study of the period 1975 to 1992 (Milroy, Med Sci Law. 1993;33:167-171; Milroy 1994; Milroy, Forensic Sci Int. 1995;71:117-122; Milroy, Med Sci Law. 1995;35:213-217; and Milroy, J Clin Forensic Med. 1998;5:61-64). Reported here is an update of that study covering HS events in the same region from 1993 to 2007. Data from cohort 1 (1975-1992) and cohort 2 (1993-2007) are presented and compared, where data are available, with the findings of 2 previous studies in England and Wales (Barraclough and Harris, Psychol Med. 2002;32:577-584; and West 1965). Homicide followed by suicide is often defined in the literature as homicide(s) followed by the suicide of the perpetrator within 1 week of the homicide(s) (Barraclough and Harris, Psychol Med. 2002;32:577-584; Campanelli and Gilson, Am J Forensic Med Pathol. 2002;23:248-251; and Hannah et al, 1998;19:275-283). All the cases reported here fall within this definition. Findings are consonant with international literature, and suggest that HS is most likely to be carried out by an older, white, married, or cohabiting working man, who kills his female partner and/or their children and then himself. There are indications that restricting access to significant methods of killing can reduce the incidence of HS.